March 2009
CHILD PROTECTION AND WELLBEING NHSGGC REFERENCE MANUAL FOR MANAGERS
Lead Manager: Marie Valente
Responsible Director: CH (C) P Directors, Directors of Acute Divisions
Approved by: NHSGGC Child Protection Forum
Date approved: 21st January 2009
Date for Review: 21st January 2012
1 CONTENTS PAGE
Executive summary 3 Introduction 5 What Young People Say 5 National Policy Background 7 National Inquires 12 Legislative Background 12 Roles and responsibilities of NHSGGC staff 13 Key definitions and concepts 20 Recognition 21 What to do if you are worried about a child 28 Tripartite discussions 28 Paediatric Medical Examinations 30 Adolescent paediatric and forensic medicals 31 Sharing of information 32 Early sharing and collation of information 33 Training 34 Key contributors 34 Consultation process 34
APPENDICES
Appendix 1 - GIRFEC diagram Appendix 2 - Assessment triangle Appendix 3 - Organisational chart Appendix 4 - Child Protection Unit leaflet Appendix 5 - Staff Leaflet (Salary slips) Appendix 6 - Social Work Contacts Appendix 7 - NHS Contacts Appendix 8 - Shared Referral Form Appendix 9 - Tripartite Discussions Diagram Appendix 10 - Early Sharing and Collation of Information Forms Appendix 11 - List of other related policies, procedures and guidance Appendix 12 - References
2
Executive Summary
This handbook sets out NHSGGC’s staff roles and responsibilities with regard to ensuring child protection and wellbeing. It aims to ensure that staff know how to act should they have concerns. It offers guidance on key aspects of child protection and wellbeing that are particularly relevant to health staff.
It describes NHSGGC’s vision for children. The overall purpose of NHSGGC is to deliver effective and high quality health services, act to improve the health of our population and reduce health inequalities. These key objectives are detailed in the children’s service planning process.
It highlights key messages from young people. Some of these are:
• Relating to, listening to, communication with young people, personality of staff • Respect their views / feelings • Give time/space • Confidentiality • Make sure they know they are loved and protected • Remove from harm • Work together • Ongoing support • Use child friendly language • Tell them not their fault
It outlines the national policy background pertaining to child protection and wellbeing, and extracts key messages for NHSGGC. The main messages from the following documents are elucidated:
• It’s Everyone’s Job to Make Sure I’m alright ,Scottish Executive, 2002 • Protecting Children and Young People: The Framework for Standards, Scottish Executive, 2004a • Protecting Children and Young People: The Charter, Scottish Executive, 2004b • Protecting Children and Young People, Child Protection Committees, Scottish Executive, 2005 • How Well Are Children and Young People Protected and Their Needs Met?: Self Evaluation Using Quality Indicators, HMIE, 2005 • Evaluation of Services for Children and Young People: Generic Quality Indicators, HMIE, 2006 • Getting It Right for Every Child: Proposals for Action, Scottish Executive, 2006a • Delivering a Healthy Future: An Action Framework for Children and Young People’s Health in Scotland, Scottish Executive, 2006b • Have we got our priorities right? Children living with parental substance use, Aberlour, 2006
3 • Hidden Harm – next Steps: Supporting Children- Working with parents, Scottish Executive, 2006c • Emergency Care Framework For Children and Young People in Scotland, Scottish Executive, 2006d • Guide to Evaluating Services for Children and Young People Using Quality Indictors” (2007) HMIE • Better Health, Better Care Action Plan, Scottish Government, 2007
It highlights the legislative background pertinent to child protection and wellbeing work, extracting relevant aspects of The Children Scotland Act (1995)
The following key concepts in child protection and wellbeing work are described and defined:
• Definition of a child • Child Abuse • Child neglect • Child in need • Significant Harm • Child protection
It offers guidance on recognition of key signs of possible child abuse.
Information on paediatric/forensic medicals is provided.
Guidance on sharing of information is provided. General principles are highlighted as follows:
• All staff have a responsibility to act to make sure that all children are protected from harm • Appropriate care is dependent on those providing that care having ready access to relevant information • If there is reasonable concern that a child may be at risk of significant harm this will “always override a professional or agency requirement to keep the information confidential” CMPO (2004)19
The main tenets of the early sharing and collation of information system are described. The Child Protection Unit acts as a “one stop shop” for social workers at the initial stage of information gathering following a child protection concern being raised. On receipt of a telephone enquiry administrative staff access health databases and where necessary, other available information in relation to an identified child or children. It is currently possible to access health data from a variety of sources available within the Unit, and this information can be made available very quickly. Information being sourced outwith the unit takes longer but in most cases it should be possible to provide social work, police and health colleagues with a list of health services together with names and contact details of key individuals who have been involved with the child, within the same working day. A summary of key information contained in the directly accessible data sources is also provided. The information collated is reviewed by the Advisor on duty prior to sharing.
The importance of training is emphasized. All staff should be trained in child welfare and protection to ensure competency in the discharge of their duties. A framework for
4 standards in this area is set out in the NHSGGC strategic Training Plan 2007. A training calendar of courses is produced regularly by the Child Protection Unit.
5 1. Introduction
1.1. NHSGGC vision for children’s services
1.1.1. NHSGGC seeks to embrace the Scottish Government’s vision for children- that they are safe, healthy, active, nurtured, achieving included, respected and responsible.
1.1.2. Our overall purpose in NHSGGC is to deliver effective and high quality health services, act to improve the health of our population and reduce health inequalities. These key objectives are detailed in the children’s service planning process. Overall objectives for NHSGGC are:
• Improve resource utilization • Shift the balance of care • Focus resources on greatest need • Improve accessibility • Modernise services • Improve health • An effective organisation.
1.1.3. So our vision is to make sure that we manage our resources effectively to protect children and young people and ensure that their needs are met.
1.3. Purpose of this policy and procedural guidance and who it is for
1.3.1. This policy and procedural guidance is for all NHSGGC managers Its purpose is to offer guidance on key aspects of child protection and wellbeing work that are particularly relevant to health staff.
2. What Young People Say
2.1 Recent developments from the Scottish Government and HMIe (Children’s Charter and Quality Indicators) have highlighted the importance of seeking the views of and listening to children and young people. This work has helped strengthen the resolve of organisations to focus more strongly on seeking the views of children and young people in respect of services provided.
2.2. NHSGGC Child Protection Unit consulted with young people (Youth Voices and Young Scot) upon what should be included in child protection training for staff. The results are indicative of what young people feel is important in child protection / wellbeing work. Young people reported the following as significant:
• Relating to, listening to, communication with young people, personality of staff • Example - Being fun, caring, calm, don’t treat like babies, listen to them, give good advice, be sensitive • Respect their views / feelings • Example - Respect them as individuals, they’ll get upset easy
6 • Give time/space • Example - Be patient, don’t touch them if scared, don’t pressurise them • Confidentiality • Example - Should be able to tell in confidence unless life threatening • Frequency of training • Example - They should be updated, it is very important • Make sure they know they are loved and protected • Example - People want to help, tell them they are loved • Telling • Example - Sometimes it is hard to tell, tell them they should tell • Remove from harm. • Example - Protect them from getting harmed, in a modern society children have the right to a loving family • Work together • Example - No one is perfect but if we work together • Ongoing support • Example - Child Line, don’t leave them • Use child friendly language • Example - No jargon • Tell not their fault • Example - They haven’t brought it on themselves.
2.3. Young people felt that the following were important messages for staff:
• Relating to, listening to, communication with young people, personality of staff • Example - Know about children, listen to them, don’t guess, be kind, don’t talk down to them, might not want to talk to someone the same sex as the person that hurt them • Respect their views / feelings • Example - Some children might be cheeky / aggressive because of it, take a step in the child’s shoes • History • Example - Should know their history, family, friends, the story of what happened • Give time/space • Example - Take time to get to know you, don’t rush them, let them get to know you
7 • Protect them • Example - Teach them to protect self, put safe adults in playgrounds • Helpline • Example - Special support number for children, Childline. • Blame • Example - Children can blame themselves • Ongoing support • Example - Fun things to do • Children with disabilities • Example - Like autism, need to be careful • Telling • Example - Understand how hard it is to tell • Other • Example - Not sure.
3. National Policy Background
3.1. The key policies that inform NHSGGC child protection work are:
• It’s Everyone’s Job to Make Sure I’m alright ,Scottish Executive, 2002 • Protecting Children and Young People: The Framework for Standards, Scottish Executive, 2004a • Protecting Children and Young People: The Charter, Scottish Executive, 2004b • Protecting Children and Young People, Child Protection Committees, Scottish Executive, 2005b • How Well Are Children and Young People Protected and Their Needs Met?: Self Evaluation Using Quality Indicators, HMIE, 2005 • Evaluation of Services for Children and Young People: Generic Quality Indicators, HMIE, 2006 • Getting It Right for Every Child: Proposals for Action, Scottish Executive, 2006 • Delivering a Healthy Future: An Action Framework for Children and Young People’s Health in Scotland, Scottish Executive, 2006 • Have we got our priorities right? Children living with parental substance use, Aberlour, 2006 • Hidden Harm – next Steps: Supporting Children- Working with parents, Scottish Executive, 2006 • Emergency Care Framework For Children and Young People in Scotland, Scottish Executive, 2006 • Guide to Evaluating Services for Children and Young People Using Quality Indictors” (2007) HMIE • Better Health, Better Care Action Plan, Scottish Government, 2007.
8 3.2. It’s Everyone’s Job to Make Sure I’m alright, Scottish Executive, 2002 is the report of the national audit and review of child protection services. The review audited the child protection practice of police, medical, nursing, social work, Scottish Children’s Reporter Administration and education staff. Some of its main findings were as follows:
• Evidence of real progress and improvement during last 20 years although not always measurable • Clear evidence of many children living in conditions and under threats that are not tolerable in a civilised society • Children, their parents and some professionals do not have confidence in the system • Children and their families do not always get the help they need when they need it • Neglect is a major cause for concern.
The report made 17 recommendations for actions placed within a three year time frame.
3.3 Protecting Children and Young People: The Framework for Standards, Scottish Executive, 2004 sets out the following broad standards for child protection services nationally:
• Children get the help they need when they need it • Professionals take timely and effective action to protect children • Children are listened to and respected • Agencies and professionals share information about children where this is necessary to protect them • Agencies and professionals work together to assess needs and risks and develop effective plans • Professionals are confident and competent • Agencies work in partnership with members of the community to protect children • Agencies, individually and collectively, demonstrate leadership and accountability for their work and its effectiveness.
3.4. Children’s Charter (Scottish Executive 2004)) indicates that children have stated that they want the system to do the following:
• Get to know us • Speak with us • Listen to us • Take us seriously • Involve us • Respect our privacy • Be responsible to us • Think about our lives as a whole • Think carefully about how you use information about us • Put us in touch with the right people • Use your power to help • Make things happen when they should 9 • Help us to be safe.
3.5. Child Protection Committees, Scottish Executive, 2005 makes clear the expectations of key agencies and their senior officials with respect to the protection of children. It also sets out in detail what is expected of Child Protection Committees themselves. The expected key outcomes from the guidance are:
• Greater strategic leadership and ownership of activity to protect children and young people • Improved co-operation between agencies at a local area in their work to protect children • Clearer understanding of the functions of Child Protection Committees and the key tasks that they should undertake in order to fulfil those functions • Better connectedness and contribution of Child Protection Committees both to the development and delivery of local services and, in sharing good practice, to child protection across Scotland.
3.6. How Well Are Children and Young People Protected and Their Needs Met?: Self Evaluation Using Quality Indicators, HMIE, 2005 contains five high level questions framing inspections. These are:
• How effective is the help children and young people get when they need it? • How effectively do agencies and the community work together to keep children and young people safe? • How good is the delivery of key processes? • How good is operational management in protecting children and meeting their needs? • How good is individual and collective strategic leadership?
3.7. Evaluation of Services for Children and Young People: Generic Quality Indicators, HMIE, 2006 focuses on developing an outcome-focused, intelligence-led and proportionate framework for evaluating children’s services. A set of generic quality indicators have been developed for use in self-evaluation and inspection. Organisations are asked to answer six high-level questions. Generic key areas are linked with each high-level question. These high level questions are:
• What key outcomes have we achieved? • How well do we meet the needs of our stakeholders? • How good is our delivery of services for children and young people? • How good is our management? • How good is our leadership? • What is our capacity for improvement?
The generic key areas are:
• Key performance outcomes • Impact on users of services for children and young people • Impact on staff • Impact on the community • Delivery of services for children and young people
10 • Policy development and planning • Management and support of staff • Partnership and resources • Leadership and direction • What is our capacity for improvement?
3.8. Getting It Right for Every Child (GIRFEC) (2007) aims to change practice and remove barriers in order to put children at the heart of all services. It promotes a unified approach to children’s services with a focus on outcomes for children, clear duties for local co-operation and co-ordination between agencies. It supports the use of a single integrated assessment tool, and a multi agency action plan where a child’s needs are complex or serious, with a lead professional to make sure this happens. See APPENDICES 1 and 2.
3.9. Delivering a Healthy Future: An Action Framework for Children and Young People’s Health in Scotland (Scottish Executive 2007) is designed to bring together the challenges facing the provision of children and young peoples health services and the actions required from the NHS and Scotland and its partners. It sets out a structured programme of actions, taken largely from existing policy initiatives and commitments and guidance regarding those actions. It makes it clear that the desired outcome is support, intervention, and service delivery that meets the needs of current and future generations of children that are:
• Targeted to the health challenges of the 21st century • Based on best evidence • Designed to protect and promote health as well as treating disease • Capable of addressing needs of children who may be vulnerable or at risk • Centred on children, young people and their families • Delivered consistently and equitably throughout the country.
The report focuses on the following aspects of child health care:
• Providing care locally • Emergency care • Hospital services • Specialist services • Child and adolescent mental health • Children with complex needs • Remote and rural care.
It emphasises the importance of working together and defines key elements for a health service fit for children and young people.
3.10. Have we got our priorities right? Children living with parental substance use, Aberlour, 2006 is the report of a Think Tank on the impact of parental drug and alcohol use on children. The Think Tank was drawn together by Aberlour from commissioners, managers, practitioners and researchers working in health, education and social work, criminal justice and drugs and alcohol services across Scotland. The report focuses on:-
What is the effect of Parental Substance Misuse?
11
• Characteristics of substance misuse • Impact of parental substance use • Key considerations for service
When should a child be removed from home?
• Principles to guide decisions • Key indicators for removal of children
What are the implications for Policy and Practice?
The Think Tank identified the following key areas for action for policy makers and services providers.
• Putting the child’s needs first • A multi agency holistic approach • Early identification • Early intervention • Assessment • Listening to children • Engagement with parents • Develop more accessible and available services for children and parents • The role of school as a safe environment and place of support • The need for clear, well understood thresholds • Training • Develop a range of care options for children • Develop parenting initiatives.
3.11. Hidden Harm – next Steps: Supporting Children- Working with parents, Scottish Executive, 2006 followed on from the publication by the Drug Advisory Council on the Misuse of Drugs of “Hidden Harm” in 2003 which highlighted the plight of children affected by parental drug use and the response by Scottish Executive in 2004 which also included parental alcohol problems. This document identifies and brings together a range of actions and initiatives to improve the way in which agencies identify, protect and support children and young people living with parental substance misuse. The key actions from the report:
• Legislation to require the sharing of information amongst agencies for child protection purposes • Improving contraception and family planning services for substance misusers • Improving the way that holistic maternity services for drug using women, addiction services and services for children and families work together • Presenting legislation to implement “Getting it Right for Every Child” to place a duty on all agencies to identify the needs of children for whom they have responsibility • Early and better identification of the needs of vulnerable children and appropriate, integrated and timely support, through “Getting it Right for Every Child”
12 • Establishing incentives for GP practices to put in place protocols so that young carers will be put in contact with local support services and support agencies • Expanding the Scottish Drug Misuse Database to ensure that information on dependent children of drug using parents is collected when clients present for treatment.
3.12. Emergency Care Framework for Children and Young People of Scotland (Scottish Executive, 2007) describes a way forward to deliver improvements in emergency care and the steps that should taken over the next three years to deliver the improvements required. The report concentrates on:
• Caring for children and young people • Emergency care for children and young people in Scotland – the key drivers • Where should children and young people receive emergency care? • Vulnerability in children and young people • Clinical care of children and young people • Staff competencies and training • Active inclusion of children and young people.
3.13. This policy acknowledges the challenge of defining vulnerability in children and young people. It urges us to recognise that in the emergency care context some children may be at particular risk of injury or harm because of personal, family or social factors. Child protection is highlighted as a significant area of service in emergency care.
3.14. Self harm is emphasized as an important area of service in emergency care. Children and young people presenting with possible/actual self harm have complex needs. Their treatment is more complex than adults and there must be appropriate referral mechanisms in place to refer on to Child and Adolescent Mental Health Services.
3.15. Better Health, Better care: Action Plan, Scottish Government, 2007 sets out a programme of work for the next five years. It sets out the government’s single, overarching purpose – to focus government and public services on creating a more successful country, with opportunities for all of Scotland to flourish, through increasing sustainable economic growth.
3.16. Ensuring that children have the best possible start in life is at the forefront of the agenda. The following are some of the actions that the Government intends to take in order to achieve this:
• Develop a long term early years strategy • Change cultures, systems and practices via GIRFEC • Implementation of Health for All • Work to protect children from the effects of drugs, alcohol and smoking • Implement Looked After Children and Young People: We Can and Must do Better • Develop specialist nurses for LAAC • Strengthen ante natal care – parents with higher needs, especially teenage mothers 13 • Promote infant nutrition • Improve breastfeeding rates • School based preventative dental services • Publish reviews of current evidence on early interventions • Extend entitlement to free school meals • Extend healthcare support for schools – start in areas with highest concentration of vulnerable children • Implement the Mental Health of Children and Young People Framework • Publish a national delivery plan for specialist children’s services • Sustain four major children’s hospitals across Scotland.
3.17. Guide to Evaluating Services for Children and Young People Using Quality Indictors” (2007) HMIE promotes consistent delivery of better integrated services for children and young people and indicates that this requires a coherent approach to quality improvement within and across all sectors. The Guide does the following:
• Lists principles which will underpin awareness raising and staff development • Identifies typical audiences, foci and outcomes for events • Reviews possible range of events • Provides a guide to content of pack of staff development materials • Gives general guidance on the management of training sessions.
3.18. Principles underpinning integrated self evaluation are elucidated as follows:
• All organisations that are responsible for delivery evaluation and improvement of services for children take responsibility for awareness raising and development of staff • A consistent approach across the country and services is needed so that separate services follow consistent approaches to evaluation • There is a cross-sector, collaborative approach to the delivery of staff development events • Events are delivered at a local level in such a way as to share knowledge and experience of evaluation methods and encourage multi-disciplinary teamwork • Events recognise that a wide spectrum of interest will have to be accommodated • Evaluation is build into events.
4. National enquiries into significant cases
4.1. Enquiries into significant cases that have influenced child welfare and protection work are:
• Social Services Inspectorate Inspection of Social Services in Cambridgeshire (Rikki Neave Inquiry), DOH, 1997 • Lord Laming, The Victoria Climbie Inquiry, HMSO 2003 • O’Brien et al Report of the Caleb Ness Inquiry, Edinburgh and Lothian Child Protection Committee, 2003
14 • Dr Helen Hammond Inquiry into the circumstances surrounding the death of Kennedy McFarlane, Dumfries and Galloway Child Protection Committee, 2000 • Professor Pat Cantrill Serious Case Review, Sheffield Area Child Protection Committee, 2005 • An Inspection into the Care and Protection of Children in Eilean Siar (The Western Isles Report), Social Work Inspection Agency, 2005 • Dr. Jean Herbison Danielle Reid: Independent Review into the circumstances surrounding her death, Highland Child Protection Committee, 2006
5. Legislative Background
5.1. The Children Scotland Act (1995) embraces the principals of the United Nations Convention on the Rights of the Child. These are:
• Protection from ill-treatment and harm • Participation in decisions affecting them • Provision of services to meet their needs.
5.2. Three overarching principals that govern the Act are:
• The child’s welfare is to be paramount consideration • Consideration must be given to the child’s views • The no order principal (principal of minimum intervention).
5.3. The Children Scotland Act (1995) sets out provision for three new orders. These are:
• Child Protection Orders • Child Assessment Orders • Exclusion Orders.
5.4. Child Protection Orders give provision for the immediate removal of a child for a period of eight working days with inbuilt appeal mechanisms within this. Child Assessments Orders last for 7 days. Exclusion Orders allow for the alleged abuser to be excluded from the family home in order to avoid the child being removed.
6. Roles and responsibilities of NHSGGC staff
6.1. NHSGGC Organisation (see APPENDIX 3)
6.1.2. Chief Executive
It is the role of the Chief Executive to exert leadership on the protection/wellbeing of children and to elucidate the vision for children’s services.
6.1.3. Strategic planning
15 The role of the Strategic planning section is to plan and performance manage child protection/wellbeing services. This is done via the NHSGGC Child Protection Forum that is supported by the Child Protection Unit. The CPU was set up to:
• Strengthen the organisation and ensure it meets its responsibilities • Ensure child protection responsibilities can be properly discharged • Ensure NHSGG&C is properly organised to operate in multi agency arrangements • Improve the protection of vulnerable children and those in the formal system • Ensure access to expert advice and support • Promote seamless care for children in the child protection process • Improve communication processes and support information sharing across the health care system and partner agencies • Ensure equity of service provision to staff • Promote standardisation and consistency of child protection practice through: Guidelines, policies, and procedures Training and education Universal documentation, proforma, and tools • Performance monitoring • Work towards framework for standards • Support clinical governance framework through clinical audit • Ensure notification and management system for referrals to and from social work • Support Child Protection Forum • Review all referrals and trigger timely and appropriate NHS input • Ensure NHS is effective at child protection committees • Manage NHS input to significant case reviews.
6.1.4. Community Health and Care Partnerships - CH(C)Ps
CH(C)Ps must make arrangements to ensure that, in discharging their functions, they have regard to the need to protect and promote the wellbeing of children. CH(C)P Directors are responsible for ensuring that the health contribution to promoting child protection/wellbeing is discharged effectively across the whole local health services. This role relates to both clinical services and wider public health responsibility for the local population. There must be integrated working across agencies to provide joined up services and a specific named health professional who has overall responsibility for ensuring adequate provision of services for vulnerable children.
6.1.5. Acute Directorates
The Acute Directorates must make arrangements to ensure that, in discharging their functions, they have regard to the need to protect and promote the wellbeing of children. Acute Directors are responsible for ensuring that the health contribution to promoting child protection/wellbeing is discharged effectively across all its health services.
6.1.6. Key Health Departments
16
6.1.7. Child Protection Unit
The Child Protection Unit should provide:
• Advice and support • Training • Significant Case Review input • Policy and procedure • Management information • Quality assurance and inspection support • Support to the paediatric and forensic medical service.
(See APPENDIX 4)
6.1.8. Human resources and recruitment
Human Resources and Recruitment Directors must ensure that there are robust safe recruitment policies and practices, including enhanced disclosure checks for those who work with children.
6.1.9 Accident and Emergency Service
A & E staff should be able to recognise certain injuries that are highly indicative of child abuse and take appropriate action. A & E staff should also be conscious of the potential risk to children in situations where a parent/ carer presents to an emergency department in concerning situations e.g. following injuries from domestic abuse, intoxicated, exhibiting mental health problems.
Staff should know how to access the child protection register and be familiar with the process of seeking that information. Staff should know how to contact social work department at all times.
Staff should be acquainted with the arrangements to notify the health visitor or school nurse of all visits made by children and young people under the age of sixteen to emergency departments.
Staff should be familiar with the recording and reporting systems in place for all cases where child abuse is suspected.
6.1.10. Substance Misuse/Addiction Services
The emphasis for staff working in this field is on the early assessment of parents who are misusing substances so that they can establish contact with other professionals involved in working with pregnant women or parents with young children.
Children and young people who are misusing substances may also be at risk and in need, so consideration should be given to involving social work staff.
17 Staff should be aware of local child protection policies and guidelines and know the standard procedure for referring children and young people to social work department.
6.1.11. Mental Health services
Health professionals who work with adults with mental health problems should always be aware of how the parents` mental state impacts on any children in the family.
Mental Health staff should liaise with colleagues in children’s services if they have concerns that their patient is unable to provide the emotional support or physical care for the children.
Staff working in adult mental health should also be aware that children of parents with chronic illness may become carers. This often leads to social isolation and a lack of emotional support.
When a parent’s behaviour or mental state poses a risk of abuse or neglect of the child, professionals need to take immediate action to protect the child by referring them to social work department. Staff should therefore be aware of and be familiar with child protection the policies and guidelines.
Where patients who are parents or carers of children are misusing drugs or alcohol staff should communicate with other professionals particularly those involved in the care of the children.
Staff working in community settings should ensure that the welfare of any children in those settings is paramount.
Mental Health Professionals involved in assessing abusers should ensure that reports written for other agencies or for child protection case conference make a clear statement of the risk to any child with whom the abuser has contact regardless of diagnosis or treatment.
Staff should also remember that issues of confidentiality are over ridden in circumstances where child protection is an issue and that the protection of a child is paramount.
Mental Health staff should also monitor the appropriateness of either children visiting adults in their care or those adults visiting children in hospital.
6.1.12. Child and Adult Mental health Services (CAMHS)
Child and Adolescent Mental Health teams have a clear role in the follow up of abused children and young people.
Staff who work in Child and Adolescent Mental Health Services may recognise, or come to suspect, that a child has suffered or is at risk of suffering significant harm. Staff need to be fully conversant with local child protection policies and procedures.
18 Staff should be aware of the referral process and require to focus on the needs of the child and young person. It is important to remember that the welfare of the child and that of any other child within the family is paramount.
The child and adolescent mental health teams may also have a role to play in the assessment of an abuser if that abuser is a child or young person. Any reports that are produced should clearly state the assessment of risk to any child with whom the abuser has any contact with irrespective of diagnosis or treatment.
6.1.13. Other health departments
All other health departments must make arrangements to ensure that, in discharging their functions, they have regard to the need to protect and promote the welfare of children. Examples of other departments are as follows:
• Psychology • Laboratories • Obstetrics and gynaecology • Occupational therapy • Physiotherapy • Podiatry • Sexual health services • Speech and language • Optometry • Pharmacy.
This list is not exhaustive.
6.1.14. All health staff
All NHSGGC health staff should:
• Have an awareness of the possibility that they may encounter children who have been abused and neglected and be alert to this possibility • Understand that they have a duty to act on any concerns about child welfare/protection • Know what to do if they have concerns • Be aware of policy and procedure relevant to their work • Be trained to a standard that equips them to carry out their child protection /wellbeing duties (see NHSGGC Strategic Training Plan 2007).
6.1.15. Health staff that work directly with children and families
All health staff that work with children and families should be able to:
• Recognise children in need of protection and/or support and understand risk factors • Recognise risks of abuse to an unborn child • Recognise the needs of parents who may need support in raising their children • Know where to refer parents and children for help/support
19 • Contribute to child welfare/protection inquiries/investigations by social work and/or police • Contribute to multi agency assessment on the needs of children and the capacity of parents/carers to meet those needs • Contribute to child protection key processes: tripartite discussions, case discussions, case conferences, core groups, children’s hearings, court hearings etc • Ensure the provision of appropriate health services • Contribute to significant case review processes • Provide written reports where required and keep adequate case records.
6.1.17. Key health professionals
6.1.18. General Practitioners
It is unusual for children to be unregistered with a GP and GPs remain a crucial first point of contact for many families experiencing difficulties. Their role is to identify, assess and continue to manage those children experiencing abuse or at risk of abuse. They should:
• Have awareness of current legislation • Provide early identification and support of vulnerable children and families • Provide full cooperation and sharing of information with agencies investigating and undertaking assessments of children at risk • Contribute to the significant case review process and understand implications for practice • Be familiar with child protection policies and procedures • Have an awareness of their role and responsibility in child protection, • Have an awareness of employed staffs’ responsibilities and meet their training needs • Receive appropriate training and at regular intervals • Ensure robust systems are in practice to identify and manage vulnerable children and families • Contribute actively in case discussions/conferences or provide adequate reports • Provide on-going support and assessment to children who are cause for concern or who are on the Child protection Register • Know how to formally refer to social work when required to do so • Have awareness of different types of abuse and how they may impact on child’s physical, mental and sexual development • Know where to access expert support and advice • Where appropriate contribute to Comprehensive Medical Assessments and to ensure on-going medical care if identified.
6.1.19. Paediatricians
The role of the paediatrician is as follows:
• Recognise when both physical and psychological problems are present and when more that one condition or disorder may be present.
20 • Recognise the diseases and host characteristics which make certain presentations life-threatening and manage these situations with vigilance and appropriate urgency • Be able to assess and manage co-morbidities associated with the range of paediatric presentations • Take a history from a child, young person and parent of the presenting difficulties to acquire information in sufficient breadth and depth in a range of possible symptom areas to allow accurate formulation of the problem • Know when to gather information from other professionals eg those working in education, social work or from others who see the child in a variety of settings • Have developed effective skills in the management of emotionally complex family situations • Understand the importance of directing communications to the baby, child or young person as well as to parents and carers • Know the range of patterns of normal development from birth to adulthood. • Know and understand the range of children’s or young people’s psychological and social development, including the normal range and what is outside it. • Understand the impact of other environmental factors (including violence, trauma, neglect, abuse and disruption, wherever this has occurred) on a child’s development, mental health and functioning • Know the reasons for faltering growth, including emotional factors and how to investigate appropriately. • Understand and assess normal and abnormal pubertal development and its relationship to growth • Understand the indirect effects of substance misuse on mental and physical health, through experimental behaviour and lifestyle, the effects on educational, emotional and behavioural development and the impact on self- care skills • Undertake comprehensive assessments, recognising indicators of significant organic disease, co-morbid, neuro-behavioural or developmental disorders (especially epilepsy and autism), interpretation of psychometric assessments and implications, reaching appropriate differential diagnosis and instituting appropriate management plans for children across the range of intellectual ability • Have a sound knowledge of consent and parental responsibility in relation to child protection examinations and the health needs of looked after children and understand the relevance of the child’s care status • Know how to assess and support the needs of children in families where there are child protection concerns • Know the appropriate investigations and management of physical injuries in relation to abuse including use of radiology, medical photography and forensic tests and the limitation of these • Know about forensic assessment in relation to child abuse and understand the importance of a chain of evidence • Recognise the role of the Forensic Odontologist in relation to bite marks. • Know when an expert genital examination is needed • Know how to access help for appropriate investigation and management of sexually transmitted disease • Know about emergency contraception and how this can be accessed
21 • Are able to recognise fabricated and induced illness including the significance of repeated or bizarre physical symptoms and be able to take appropriate action and know when and where to access help • Know the medical conditions that may mimic abuse of all kinds. • Able to conduct an assessment for physical abuse • Able to assess injuries in relation to history, developmental stage and ability of the child • Able to recognise when additional expert advice is needed, for example radiology, orthopaedics, neurology, ophthalmology • Able to recognise signs of abuse in disabled children and know that this group is more vulnerable • Able to provide the medical opinion to case conferences, strategy meetings and court hearings • Able to compile and write the range of reports required in child protection work including police statements, medical reports from social services and court reports.
6.1.20. Health Visitors
The role of the health visitor in Child Protection is to observe, assess record, refer, and provide support. Child Protection work is an essential part of the role and responsibilities of the health visitor. Health Visitors are accountable for their practice in accordance with the NMC guidance and should ensure that the key activities are undertaken with safe practice at their core.
The role of the health visitor includes:
• Early recognition of parenting and attachment difficulties • Opportunity to monitor developmental wellbeing including physical and emotional development and to detect deviation from the norm • Initiation of early intervention to prevent abuse and promote child wellbeing
Health Visitors have a responsibility to:
• Identify, assess and refer children at risk of abuse or neglect to the appropriate agencies • Contribute to the prevention of abuse and neglect through supporting and working in partnership with vulnerable families • Familiarise themselves with procedures for making referrals to social work departments • Familiarise themselves with procedures and policies relevant to their work in Child Protection • Work in partnership with colleagues to promote the wellbeing of children and prevention of abuse and neglect • Contribute to the appropriate Child Protection Case Conferences, Discussions, Reviews and planning meetings for children on the Child Protection Register or who are giving cause for concern • Be aware of how to seek advice and support e.g. from the Child Protection Unit and/or line managers.
22 Health Visitors have a very important role to play in protecting children.
6.1.21 School Nurses
The role of the School nurses in Child Protection is to observe, assess record, refer, and provide support.
The school nurse has a responsibility and opportunity to identify child protection and wellbeing issues in several ways. This will include:
• Opportunistically during school health screening • Through listening and observing children in the school environment • Through informal approaches from children or through "drop-in clinics" • Ensuring that records are up to date and accurate.
School nurses have a vital role and responsibility in relation to liaison with a variety of other professionals where there are Child Protection concerns. This will involve:
• Contact with health visitors, particularly when children enter school or transfer between schools • Discussion with school staff and guidance teachers where there are concerns about a child • Liaison with parents where problems are identified within school • Referral to other agencies including social work departments • Contributing to the appropriate Child Protection Case Conferences, Discussions, Reviews and planning meetings for children on the Child Protection Register or who are giving cause for concern • Be aware of how to seek advice and support e.g. from the Child Protection Unit and/or line managers.
6.1.22. Midwives
The role of the midwife in child protection is to assess and identify risk factors to the child during the pregnancy, birth and post natal period both in the community and hospital settings.
The responsibilities of the midwife include:
• Early identification of vulnerable women who are pregnant • Preparation for parenthood for vulnerable women • Familiarisation with procedures and policies relevant to their work in Child Protection • Familiarisation with procedures for making referrals to social work departments • Contributing to the appropriate Child Protection Case Conferences, Discussions, and Reviews and planning meetings for children on the Child Protection Register or who are giving cause for concern. • Be aware of how to seek advice and support e.g. from the Child Protection Unit and/or line managers.
23
6.1.23. Dentists
The role of the dentist in child protection is to identify physical injury especially to the facial and oral regions.
They are also well placed to identify neglect which may include dental caries, poor oral hygiene and the need for extensive dental extractions. This may include poor dental care of children's teeth, unsuitable diet and failure by parents to seek and carry out appropriate treatment or advice
The responsibility of the dentist is to assess and refer to Social Work departments where they consider a child may have been physically injured or neglected. They should be aware of local referral arrangements and have access to contact details should a referral be appropriate
6.1.24. Other health professionals
All other health professionals should have knowledge of relevant procedure and should receive training and supervision on child welfare and child protection. Examples of such staff are as follows:
• Psychologists • Psychiatrists • Gynaecologists • Counsellors • Occupational therapists • Physiotherapists • Optometrists • Pharmacists • Podiatrists.
This list is not exhaustive.
7. Key Definitions and Concepts
7.1. Definition of a child
For the purpose of support for children in need and their families under the Children (Scotland) Act 1995 “child” means a person under the age of sixteen years. Young people between the age of sixteen and eighteen years who are still subject to a supervision requirement by a Children’s hearing can still be viewed as a child.
7.2. Child Abuse
There is no standardised definition that has been developed by researchers and accepted and used by practitioners. Definitions of child abuse vary amongst professionals, over time and across cultures and between social and cultural groups. The World Health Organisation state that the core elements of abuse should refer to;
24 • the child • the abusing agent; and • indirect harm caused by the abuse.
They provide a general definition of child abuse and maltreatment:
“Child abuse or maltreatment constitutes all forms of physical and/or emotional ill treatment, sexual abuse, neglect or negligent treatment or commercial or other exploitation, resulting in actual or potential harm in the child’s health, survival, development or dignity in the context of a relationship of responsibility, trust or power”.
The official definition of child abuse in Scotland was devised by (Scottish Office Social Work Services Group 1992) to provide standard criteria for admission to, and removal from local registers:
“Children may be in need of protection where their basic need are not being met in a manner appropriate to their stage of development and they will be at risk from avoidable acts of commission or omission on the part of their parent(s), sibling(s), from other relative(s), or a carer (i.e. the person(s) while not a parent who has actual custody of a child). To define an act or omission as abusive and/or presenting future risk for purpose of registration a number of elements must be taken into account. These include demonstrable or predictable harm to the child which must have been avoidable because of action or inaction by the parent or other carers” (Protecting Children a Shared Responsibility – Scottish Office 1998).
7.3. Child Neglect
“This occurs when a child’s essential needs are not met and this is likely to cause impairment to physical health and development. Such needs include food, clothing, cleanliness, shelter and warmth. A lack of appropriate care results in persistent or severe exposure, through negligence, to circumstances which endanger the child” (Protecting Children a Shared Responsibility – Scottish Office 1998). Physical neglect may also include a failure to secure appropriate medical treatment for the child, or when an adult carer persistently pursues or allows the child to follow a lifestyle inappropriate to the child’s developmental needs or which jeopardises the child’s health
7.4. Child in Need
The concept of ‘need’ is defined in the Children (Scotland) Act 1995 P ll S.93 as follows: “Any reference in this Part of this Act to a child being “in need”, is to his being in need of care and attention because;
i. he is unlikely to achieve or maintain, or to have the opportunity of achieving or maintaining, a reasonable standard of health or development unless they are provided for him, under or by virtue of the Part, services by a local authority; ii. his health or development is likely significantly impaired, or further impaired, unless such services are provided; iii. he is disabled; or iv. he is adversely affected by the disability of any other person in his family;”
25 The legislation is intended to enable authorities to respond to a wide range of individual needs.
7.5. Significant Harm
Some children are in need because they are suffering or likely to suffer significant harm. The Children (Scotland) Act 1995 introduced the concept of significant harm as the threshold that justifies compulsory intervention in family life in the best interests of children, and gives local authorities a duty to make enquiries to decide whether or not they should take action to safeguard or promote the welfare of a child who is suffering, or likely to suffer, significant harm. Whilst the Act does not provide a definition for “significant harm”, it is acknowledged that significant harm can be as a result of a ‘one off’ incident, a series of ‘minor ‘ incidents or as a result of an accumulation of concerns over a period of time (Inter-agency Guidelines GCPC 2001). In assessing significant harm, a number of factors should be considered:
• the duration and the severity of the abuse • the actual, or potential, impact on the child’s health, development or welfare • the context of the any alleged incident i.e. age of the child, level of understanding etc • parental attitude and willingness to co-operate • the presence or absence of any protective factors • the child’s reactions and/or views.
7.6. Child Protection
Since the inquiry into the events at Cleveland the emphasis has shifted from a focus on the concept of child abuse to a focus on the concept of child protection (Parton 1997). The focus is on the identification of children who are being harmed or are likely to be harmed and the action which may be taken to prevent further harm to such children. For social workers and the police the focus of child protection is to protect children and young people from abuse, they have a legal responsibility to investigate alleged instances of such abuse and to follow legal and professional guidelines. Protecting Children A Shared Responsibility (Scottish Office 1998) and Working Together to Safeguard Children (Department of Health et al 1999) conform to this approach to defining child protection.
8. Recognition
8.1. The following section is adapted from “Child Protection Companion, Royal College of Paediatrics and Child Health, April 2006
8.2. Bruises
Non abusive bruising in children has a direct correlation to the developmental stage of the child under 5 years. Non mobile children should not have bruises without a clear and often observed explanation. All such bruises should be carefully assessed including seeking witness/independent observer accounts.
Certain areas are rarely bruised accidentally at any age, including neck, buttocks and hands in children less than 2 years. Common and important sites for non accidental bruises are:
26
• Buttocks and lower back • Slap marks on side of face, scalp and ears • Bruises on external ear • Neck, eyes and mouth • Trunk including chest and abdomen • Lower jaw and mastoid.
Two black eyes may follow blood tracking down from the forehead from a substantial injury. This may involve the skin around the eyes but not the orbit. If this is accidental, there should be a consistent account of an accident/incident a few days before (i.e. a memorable event).
Bruises associated with sexual abuse include lower abdomen bruises, grip mark patterns around buttocks, thighs knees and genitalia
The face is the most commonly bruised site in fatally bruised children.
Clustering of bruises or those which show a negative or positive image of an implement are very significant.
8.3. Bites
Bites are always inflicted injuries. They can be animal or human – adult or child.
8.4. Fractures
It takes considerable force to produce a fracture in a child or infant. All fractures require appropriate explanation and this must be consistent with the child’s developmental age. Abusive fractures are frequently occult, particularly rib fractures (Merten, Radkowski & Leonidas 1983). Assessment requires interface between paediatrician, paediatric A&E, paediatric radiology and paediatric orthopaedics wherever possible (see RCPCH/RCR 2006).
Age
The younger the child the greater the likelihood of abuse. 80% of abused children with fractures are less than 18 months old, whereas 85% of accidental fractures occur in children over five years Infants less than four months of age with fractures are more likely to have been abused
The following fractures are more suspicious of abuse:
Humerus
Spiral fractures of the humerus are uncommon and strongly linked with abuse. Any humeral fracture other than a supracondylar fracture is suspicious of abuse in children (Leventhal et al 1993; Strait, Seigel and Shapiro 1995; Thomas et al 1991; Worlock, Stower and Barbor 1986). All humeral fractures in a non-mobile child are suspicious if there is no clear validated/witnessed history of an accident.
27 Multiple fractures
Multiple fractures are significantly commoner in abused children, (Warlock, Stower & Barbor 1986).
Ribs
In the absence of underlying bone disease or major trauma (such as a road traffic accident), rib fractures in very young children are highly specific for abuse, and may be associated in some cases with shaking.
Posterior rib fractures have never been described following resuscitation. Anterior and costochondral rib fractures have been described extremely rarely, in 0.5% of resuscitated children. If fractures are present on a chest x-ray after resuscitation they must be investigated on the basis that they occurred before admission. Dating of the fractures may be crucial in this assessment but the evidence suggests that this cannot be done with accuracy. Remember anterior rib fractures may also occur in child abuse.
Posterior rib fractures are relatively more common in abuse and must be looked for carefully, as they are easily missed. A skeletal survey must include oblique views of the ribs to maximise detection
Femur
Femoral fractures in children who are not independently mobile are suspicious of abuse, regardless of type.
Once a child is able to walk, they can sustain a spiral fracture from a fall while running.
A transverse fracture of the femur is the commonest presentation and can be found in accidental and non-accidental injuries.
Skull fractures
Like other fractures, skull fractures require considerable force. A linear parietal fracture is the commonest accidental and non-accidental fracture.
Other skull fractures require a greater degree of force, which should be reflected in the history.
Up to 88% of abusive skull fractures occur under one year of age. This is also the commonest age for accidental skull fractures.
8.5. Emotional abuse
Emotional abuse is one of the most damaging forms of abuse and also almost always accompanies other forms of abuse. It includes persistent criticism, denigration, rejection and scapegoating.
Symptoms and signs are non-specific, and include the following:
Babies:
28 • Feeding difficulties, crying, poor sleep patterns, delayed development • Irritable, non-cuddly, apathetic, non-demanding. Described as: ‘difficult infant, not belonging to me’, ‘doesn’t love me’, ‘spoiled’. Also ‘greedy, attention seeking, lazy, in control of mother’.
Toddler and pre-school child:
Head banging, rocking, bad temper, ‘violent’, clingy. Spectrum from overactive to apathetic, noisy to quiet. Developmental delay especially language and social skills.
School child:
Wetting and soiling, relationship difficulties, poor performance in school, non-attendance, antisocial behaviour. Feel worthless, unloved, inadequate, frightened, isolated, corrupted and terrorised.
Adolescent:
Depression, self harm, substance abuse, eating disorder, poor self-esteem. Oppositional, aggressive and delinquent behaviour.
Categories of ill-treatment within emotional abuse and neglect
Emotional unavailability, unresponsiveness and neglect:
• The primary carers are usually preoccupied with their own particular difficulties such as mental health (including post-natal depression) and substance abuse or with overwhelming work commitments. They are unable or unavailable to respond to the child’s emotional needs, with no provision of an adequate alternative • Extremely little or no emotional or psychological interaction between the carer and the child (emotional unavailability) • Negative attributions and misattributions to the child • Hostility towards, denigration and rejection or humiliation of a child, who is perceived as deserving these • The child is repeatedly harshly criticised or blamed by the carer • The child is ‘scape goated’ by the carer • The child is described by the carer as having the ‘bad genes’ or the negative traits of a disliked or hated person
Developmentally inappropriate or inconsistent interactions with the child:
• Expectations of the child beyond her/his age and developmental capabilities • Over-protection and limitation of exploration and learning, for example keeping child in pushchair for prolonged periods • Exposure to confusing or traumatic events and interactions, for example, domestic violence, numerous changing partners, drug and alcohol abuse • The parents/carers lack of knowledge of age-appropriate care giving and disciplining practices and child development, often because of their own childhood experiences. Their interactions with their children, while harmful, are thoughtless and misguided rather than intending harm
29 • The child is given responsibility which he/she is developmentally unable to fulfil, for example, parenting younger children or caring for their own parents, or which impedes their development, for example, education, peer relationships, own protection • The child is treated in a punitive, harsh or inappropriate manner as a result of the carer’s lack of awareness or understanding • The child is exposed to confusing, distressing, disturbing or bizarre behaviour (e.g. intrafamilial (domestic) violence and parental (para) suicide)
Failure to recognise or acknowledge the child’s individuality and psychological boundary:
• Using the child for the fulfilment of the parent’s/carer’s psychological needs • Inability to distinguish between the child’s reality and the adult’s beliefs and wishes • The child is used by the carer as a partner, friend, confidant • The child is expected to fulfil the parent/carer’s ambitions • The parent/carer needs the child to be treated as ill; this includes Fabricated or Induced Illness (FII Section 6:12).
Failing to promote the child’s social adaptation:
• Promoting mis-socialisation (including corrupting) • Psychological neglect (failure to provide adequate cognitive stimulation and/or opportunities for experiential learning) • The child is deprived of the opportunity to develop peer relationships, including the carer not facilitating school attendance • The child is allowed or encouraged to misuse illegal drugs • The child is allowed or encouraged to be involved in criminal activities • Failure to provide adequate cognitive stimulation, education and/or experiential learning; intellectual deprivation
8.6. Neglect
Forms of neglect include:
• Neglect of a child’s physical needs, eg. Nutrition/hygiene/clothing • Neglect of a child’s medical needs • Neglect of supervision and lack of awareness of safety issues • Failure to ensure the child receives stimulation and education appropriate to their age and level of development • Neglect of a child’s social needs, eg. child not given opportunities to mix with peers • Failure to provide affection and appropriate nurturing • Failure to pay attention to child’s personal hygiene, clothing etc.
Presentations
• Frequent A&E attendance (eg. for injuries). These are often associated with accidents through lack of supervision • Poor uptake/attitude to immunisations
30 • Untreated medical conditions and not giving essential treatment regularly or consistently for serious illness and/or minor health problems • Physical care and presentation of the child outside acceptable norms for the population (eg. Inappropriate clothing for the weather) • Parent/carer does not have the ability and/or motivation to recognise and ensure the needs of the child are met
Assessment
Neglected children may present with:
• Failure to thrive through lack of understanding of dietary needs of a child or inability to provide an appropriate diet; or they may present with obesity through inadequate attention to the child’s diet • Craving attention or ambivalent towards adults, or may be very withdrawn. • Being too hot or too cold – check hands/feet for cold injury – red, swollen and cold hands and feet (Hobbs, Hanks and Wynne 1999) or they may be dressed in inappropriate clothing • Consequences arising from situations of danger – accidents, assaults, poisoning, other hazards (lack of safeguarding) • Delayed development and failing at school (poor stimulation and opportunity to learn) • Difficult or challenging behaviour (failure of parenting) • Unusually severe but preventable conditions owing to lack of awareness of preventive health care or failure to treat minor conditions • Health problems associated with lack of basic facilities such as heating.
8.7. Sexual Abuse
Children who have been sexually abused may present in many ways.
The abuser frequently grooms and threatens children so that a clear disclosure is not often made at an early stage in the process.
There are very few absolutely diagnostic signs. The aim should be to build up a wider jigsaw picture of the child which should include the child’s story, behaviour and presentation.
The following are ways in which children may present – this is by no means an exhaustive list, but a guide to the type of concerns, which should raise suspicions
Concerning signs/symptoms are:
• Vaginal bleeding • Rectal bleeding • Vulvo vaginitis with or without dysuria (pain on passing urine) • Infection including anogenital warts • Masturbation (It is normal for children to masturbate, however, this may be considered worrying if ‘excessive’- usually defined as excessive if in public/interfering with life. Masturbation does not usually cause physical signs or injury)
31 • Foreign body in vagina/anus • Soiling/bowel disturbance/enuresis • Behavioural presentation: o Children may present with various behaviours including self harm/mutilation, aggressive and sexualised behaviours as well as psychosomatic symptoms.
o Children can express their distress following sexual abuse in a wide variety of ways (eg. Nightmares, poor school performance, regression, anxiety and increased attachment behaviour). Any major change in a child’s behaviour should prompt a search for the cause and abuse should be considered if there is no obvious explanation. Definitive diagnostic presentations are:
• Pregnancy • Some sexually transmitted infections. • Presence of semen/sperm.
8.8. Fabricated or Induced Illness (FII)
FII is a form of abuse, not a medical condition. Previously known as Munchausen Syndrome by Proxy, this label applies to the child, not the perpetrator. The label is used to describe a form of child abuse.
There is a spectrum of fabricated illness behaviour, and FII may co-exist with other types of child abuse. The range of symptoms and systems involved is very wide and it is usually the parent or care giver who is the perpetrator. FII includes some cases of suffocation, non-accidental poisoning and sudden infant death.
Features are:
• A child is presented for medical assessment and care, usually persistently, often resulting in multiple medical procedures • Mismatch or incongruity between symptoms described by parent/carer and those objectively observed by medical attendants • The perpetrator denies knowledge of the aetiology of the child’s illness • Acute symptoms and signs cease when the child is separated from the perpetrator • Intentional or non-accidental poisoning often presents with bizarre symptomatology – a range of substances are involved (eg. Methadone, salt).
The paediatrician is usually the professional who firsts suspects FII.
8.9. Domestic violence/abuse
All professionals working with women and children should be alert to the inter-relationship between domestic violence and the abuse and neglect of children.
Presentation
32 • Effects on victim: social isolation, physical injuries, mental health problems • Parenting problems: undermining of parenting ability and ability to protect children • Effects on child: fearful, withdrawn, anxious, lacking in self confidence and social skills, difficulties in forming relationships, sleep disturbance, non- attendance at school, aggression, bullying, post traumatic stress disorder, behaviour suggestive of ADHD
8.10. Adult mental health and child protection
It is well recognised that parental mental health problems have a significant effect on the well being of children and may lead to concerns about harm.
However, not all children whose parents are mentally ill suffer adversely as a result. It is important that both Adult and Children’s services recognise the overlap between child protection and parental mental illness. The best way forward is collaborative working between these services.
8.11. Substance misuse
Parental problems, alcohol and drug use can, and often does, compromise children’s health, development and welfare at every stage from conception onwards. When parents are suspected to have a problem with substance abuse, the paediatrician should consider the following questions:
General:
• Are there any factors which make the child(ren) particularly vulnerable, for example a very young child, or other social needs such as physical illness, behavioural and emotional problems, psychological illness or learning disability? Are there any protective factors that may reduce the risks of harm to the child? • How does the child’s health and development compare to that of other children of the same age in similar situations? • Are children usually present at home visits, clinic or office appointments during normal school or nursery hours? If so, does the parent/carer need help getting children to school? • How much money does the family spend on alcohol/drug use? Is the income from all sources presently sufficient to feed, clothe and provide for children, in addition to obtaining alcohol/drugs? • What kind of help do you think the child needs? • Is there evidence of neglect, injury or abuse, now or in the past? What happened? What effect did/does that have on the child? Is it likely to recur? • Is the concern the result of a single incident, a series of events, or accumulation of concerns over a period of time? • Do the parents/carers perceive any difficulties and how willing are they to accept help and work with professionals?
33
Drugs Specific:
• What arrangements are made for the child(ren) when the parent/carer goes to get illegal drugs or attends for supervised dispensing of prescription drug(s)? • What do you think might happen to the child? What would make this likely or less likely? • Do parent/carer(s) think that their child knows about their problems alcohol or drug use? How do they know? • What does the child think? What do other family members think? How do you know? • Is there a failure on the parent/carer(s) part to maintain contact with helping agencies? • Who will look after the child(ren) if the parent/carer is arrested or is in custody?
Alcohol Specific (HMSO 2003; Scottish Executive 2003):
• What is the current pattern and level of use? Type and amount of alcohol consumed/where/when/alone or with others? If with others, with whom? When and where does this occur? • Is this typical of the last three months? • Tendency to binge drink or drink every day? • How is alcohol financed?
9. What to do if you are worried about a child
If you are worried about a child being abused or neglected or at risk of being abused and neglected staff should do the following:
• Document exactly what you see and hear
• Report exactly what you see and hear to your supervisor, line manger or colleague
• If you need advice you can contact the Child Protection Unit Advice Line on 0141 201 9225 (daytime) or the Medical Advice Line on (Out of Hours) contact RHSC Switchboard on 0141.201.0000
• Report your concerns to Social Work by telephone (See APPENDIX 6) and follow up in writing within 48 hours using Shared Referral Form. (See APPENDIX 8)
• If an emergency report your concerns to police on 0141 427 8081
Doing nothing is not an option.
(See APPENDIX 5 (Leaflet), APPENDIX 6 (social work contacts) APPENDIX 7 (Health contacts))
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10. Tripartite Discussions (IRD’s – Initial Referral Discussions)
(See APPENDIX 9)
10.1. The involvement of the NHSGGC is an essential component in the multi-agency assessment of children at risk of child abuse and neglect. NHS involvement should take place during the course of all child protection investigations.
10.2. Arrangements to facilitate tripartite discussions are currently under development. The following has been agreed in some areas but at the time of writing full rollout is not yet implemented. Optimum arrangements are now described.
10.3. When a CP1 is opened, the responsible social worker discusses the case with relevant local NHS personnel such as the child’s Health Visitor, GP or School Nurse.
10.4. In every CP1 case, the responsible social worker also phones the NHSGGC Child Protection Unit (CPU) who gathers and shares additional Health information such as:
On site at Yorkhill
• CHI • Reports to Reporter from HV • NHS 24 • HISS (includes Yorkhill notes plus A & E cards) • CPU Medical advice line • CPU Nurse Advisor Advice line • Missing Family Alerts • Educational download.
In addition the following can be checked via telephone or email:
• DCFP/CAMHS • Child Protection Advisors – Other Health Board Areas • LAAC.
10.5. This information will be augmented over time and direct access via IT systems progressed.
10.6. During contact with the Child Protection Unit, if it appears that a medical may be required, an agreement will also be reached with a paediatrician on the following:
• Whether a one doctor comprehensive medical assessment is required, what it is likely to achieve and its urgency • Whether a two doctor paediatric / forensic examination is required • Who should conduct the medical assessment • Where and when it should be conducted.
35 10.7. When it has been agreed that a Comprehensive Medical Assessment is required the CPU will liaise locally with the appropriate paediatrician.
10.8. It is expected that the great majority of CP1 cases will be dealt with during working hours. After normal working hours, a medical assessment, if appropriate, may be arranged with the Consultant Paediatrician via the Royal Alexandra Hospital switchboard or via Yorkhill. (Later via Inverclyde Royal also).
10.9. All examining Paediatricians will use the standardised proforma for single and joint medical examinations.
10.11. Timing around Medical Assessments
• With physical injury it is important to arrange a medical as soon as possible so that signs of injury such as bruising do not fade • If physical neglect is acute then an examination must be carried out as soon as possible. If not, time can be taken to arrange a comprehensive health assessment • If there has been any form of recent sexual assault, it is imperative to arrange a medical examination at the earliest appropriate time • In situations where the general practitioner is unsure whether the clinical presentation is due to abuse or illness, for example a child with unexplained severe bruising which could be due to a haematological condition, referral to the hospital for a paediatric opinion prior to initiating inter-agency discussions may be indicated. This would not be regarded as the formal planning meeting or discussion but a request for a paediatric opinion • The child and family should be kept appropriately informed of the medical findings and should be supported throughout the process • Once Child Protection investigations are under way, the progress of the health component will take place in parallel to other aspects of the police and social work enquiries.
10.12. Consent to Health Assessment
10.13. Children under 16 can give their own consent if the medical practitioner attending the child considers the child capable of understanding the nature and possible consequences of the procedure or treatment. If the child is judged capable, the practitioner must seek the consent of the child rather than of the parent.
10.14. Where a child is judged incapable of consenting, consent should normally be obtained from a person with parental responsibilities and rights.
10.15. It should be noted that, if a child is capable of giving his or her own consent, the parents lose any right they may have had to consent on the child’s behalf. This does not mean that parents must always be excluded from the discussions. Unless there are issues about the child’s confidentiality, it would be reasonable to involve parents in helping the child to reach a decision. This would be consistent with the philosophy of partnership with parents which underlies the Children (Scotland) Act. However, if the child is judged competent, it is the child’s consent alone that is legally effective.
36 10.16. When a parent or carer is a suspect, or for some reason not supportive of their child’s needs, then their attendance during a health assessment may not be appropriate. Any exclusion of a parent or carer should be fully discussed by all the agencies in advance of the health assessment.
10.17. The child will be required to be accompanied by a parent or other trusted adult during this process.
11. Paediatric and Forensic Medical Examinations
11.1. The following outlines the types of paediatric medical examination required when children are suspected of being abused or at risk of harm. There are four types of medical examination:
11.2. Comprehensive Medical Assessment
A Comprehensive Medical Assessment is an essential component in the multi-disciplinary assessment of suspected/ potential child abuse or children at risk of harm. This would involve the greatest numbers of children. Many chronically neglected children as well as physically abused children do require this at some point. The Comprehensive Medical Assessment has five purposes:
• Establish what immediate treatment the child may need • Provide information which may or may not support a diagnosis of child abuse in conjunction with other assessments made, by analysis of facts and clinical presentations and provision of paediatric opinion. Agencies can initiate or continue enquiries as appropriate • Provide information/evidence, if appropriate, to sustain care plans and/or criminal proceedings • Secure any ongoing medical care (including cultural welfare/ mental health), monitoring and treatment that the child may require • Assess and reassure the child and family as far as possible that no long term physical damage or health risk has occurred • Record on standardised documentation (MCN standard) and provide reports as required to professionals, agencies and legal system.
11.3. Single Specialist Paediatric Examinations
These are provided in cases where there are possible indicators of sexual abuse but the indicators are not sufficient to instigate a full police enquiry e.g. marked inappropriate sexualised behaviour in a pre-school child with no allegation of abuse. Skilled intimate examination of a child is also required when there is e.g. chronic vaginal discharge or potential foreign body insertion. Social Work and Heath staff may in addition have ongoing child welfare concerns and there may be anxieties expressed by the mother/carer re potential problems or damage to the genital / anal area. Paediatricians with specialist knowledge in intimate genital examinations are required to perform these examinations within appropriate facilities. These cases are also sometimes referred by GPs or hospital staff who have concerns regarding unusual genital anatomy in a child. A child clinical vulvoscopy facility is the optimal setting.
37 11.4. Joint Paediatric/Forensic Medical - Two Doctors – optimally Consultant Paediatrician and Police Child Examiner. This is conducted if:
• The child urgently requires a follow-up assessment investigation or treatment at a Paediatric Department e.g. head injury, possible fractures/unusual bruising/burns patterns • The account of the injuries provided by the carer does not provide an acceptable explanation of the child’s presentation • The result of the preliminary assessment is inconclusive and a specialist opinion is required to establish the diagnosis • Lack of corroboration of the allegation such as a clear statement from another child or adult witness indicates that forensic examination, including the taking of medico-legal photography, may be necessary as part of the process to support legal remedies to protect the child and criminal proceedings against the perpetrator • The child’s condition (e.g. failure to thrive/ malnutrition) requires further investigation. 11.5. Specialist Paediatric Examination/ Shared Care with other Medical and Surgical Specialists -
e.g. general paediatric surgeons, burns surgeons, paediatric orthopaedic surgeons, general surgeons, psychiatrists
These medicals are generally the most complex cases and are requested mainly via two routes:
• Other medical specialist currently in charge of the child’s clinical care • Police / social work investigating the case requiring more specialist advice/opinion.
They are requested because the consultant involved has reached their level of competency in their area and require specialist advice/opinion./shared care. Shared care is where the specialist child protection paediatrician provides analysis and opinion in relation to for example patterning of injuries, consistency or otherwise of history provided, for clinical presentations, interpretations of sexually transmitted infections in children, balanced judgement with regard to differential diagnosis in unusual features of presentation.
12. Adolescents 13 – 16 years or 18 if looked after and accommodated by local authority): Paediatric and Forensic Medicals
12.1. The aim is to ensure early Identification of child protection / wellbeing concerns at point of health contact / input.
12.2. Staff within particular health areas have a key role to play: • A & E Departments • GP Practices • GEMS • Minor Injury Units • Paediatric departments (in future seeing more adolescents patients) 38 • Community Paediatricians and Integrated teams within CHCP’s • Sexual Health Services • Mental Health Services • Learning Disability Services • Homelessness Services.
12.3. Early information must be shared within Health and with other agencies, in particular with social work departments and police, as per interagency Child Protection guidelines, to ensure appropriate assessment and/or investigation and intervention (and not be hindered by individual/subjective views on consent/confidentiality).
12.4. Comprehensive medical assessments and / or paediatric forensic medical assessments should occur within nominated appropriate Health facilities by appropriately trained medical staff and specialist nursing staff. This may be in dedicated facilities within CHCP’s or within appropriate facilities in the hospital setting. Police Child Examiners should be available as required for joint examinations. In these circumstances there should be formalised arrangements put in place for ready access to Mental Health services when required
12.5. Standardised Health Service Child Protection documentation across Glasgow and Clyde for 12 - 16yr olds to document clearly and comprehensively all child protection / wellbeing concerns including body charts illustrating physical injuries (and appropriate medico-legal photography by medical illustration departments or police photographers) will be introduced.
12.6. Archway (Glasgow only) provides a service for adolescents that have been subject to acute serious sexual assault. Medical examinations in suspected or acute sexual assaults experienced by young people under 16 years considered “not competent” by set criteria or who have developmental immaturity will occur on “Archway” premises at the Sandyford Centre or when required on paediatric premises. Archway staff can contact the paediatricians on the 24/7 rota for advice and /or assistance.
13. Sharing of information
13.1. Key legislation regarding information sharing is as follows: • The United Nation Convention on Rights of the Child, 1989 • Age of Legal Capacity Act (Scotland) 1991 • The Children (Scotland) Act 1995 • The European Convention of Human Rights (ECHR) • The Data Protection Act 1998 • Freedom of Information (Scotland) Act 2002.
13.2. There are several national documents that offer guidance on sharing of information. These are as follows: • Sharing Information about Children at Risk – A Guide to Good Practice, Scottish Executive 2004 • Protecting Children: A Shared Responsibility (Interagency Guidance), 1998 39 • Protecting Children: A Shared Responsibility Guidance for Health Professionals, 2000 • General Medical Council Guidance on Confidentiality, 2000 • Protecting and Using Patient Information: A Manual for Caldicott Guardians 2000 • NMC Code of Professional Conduct 2004 • NHS Scotland Code of Practice on Protecting Patient Confidentiality, 2003 • Responsibilities of Doctors in Child Protection cases with Regard to Confidentiality, RCPCH 2004.
13.3. General principles are as follows: • All staff have a responsibility to act to make sure that all children are protected from harm • Appropriate care is dependent on those providing that care having ready access to relevant information • If there is reasonable concern that a child may be at risk of significant harm this will “always override a professional or agency requirement to keep the information confidential” CMO (2004)
13.4. Where possible staff should involve children and parents in the decision to share information. However, the paramount consideration is the care and wellbeing of the child. Children and parents need not be involved in decisions about the disclosure of information if this would increase the risk to the child, parents or staff.
13.5. When any professional approaches another to ask for information they should explain:
• What information they need • Why they need it • What they will do with the information • Who else may need to be informed if concerns about a child persist.
13.6. If a professional is asked to provide information, they should never refuse solely on the grounds that all their information is confidential. They should consider:
• What information the service user has already given permission to share • Any perceived risk to a child which would warrant breaching confidentiality • Any relevant information on risk to the child, which would allow another agency to offer appropriate help and services or take action to reduce the risk to the child.
13.7. Staff should record when, what and why information has been shared, and with whom.
14. Early sharing and collation of information
14.1. Several national policy documents and Significant Case Reviews have highlighted concerns about the lack of timeous and comprehensive collation of information, which often hampers decision making. Access to as full a range of information
40 regarding children where there are child welfare concerns is crucial to their protection. Current systems are complex, often difficult to navigate around, and where a child is known to multiple health services, information is held in several locations and not always cross-referenced. This can be frustrating and confusing for partner agencies, particularly at the early stages of any child protection investigation. Since the inception of the Child Protection Unit in 2005 work has been done to develop and maintain systems which help to inform and support the work of the Unit in a variety of ways. This has yielded a rich source of information either held locally or easily accessible by Unit staff. This information can be shared with partner agencies when considered appropriate to do so to support child protection processes.
14.2. The Child Protection Unit acts as a “one stop shop” for social workers at the initial stage of information gathering following a child protection concern being raised. This process should augment already existing social work systems. On receipt of a telephone enquiry administrative staff access health databases and where necessary, other available information in relation to an identified child or children. It is currently possible to access health data from a variety of sources available within the Unit, and this information can be made available very quickly. Information being sourced outwith the unit takes longer. The aim is to provide social work, police and health colleagues with a list of health services together with names and contact details of key individuals who have been involved with the child, within 24 – 48 hours. A summary of key information contained in the directly accessible data sources is also provided. The information collated is reviewed by the Advisor on duty prior to sharing.
14.3. Advantages of the system are as follows:
• One point of contact for social work, police and health service in identifying sources of health • information • Speedy access to a range of health systems • Identification of key health personnel who have involvement/information about a child - this may be • particularly relevant for the over 5’s and those children accessing a wide range of health services • Historical, as well as current data can be accessed - this may be particularly helpful in relation to previous attendances at A&E, previous admissions to hospital and history of G.P registrations • As the CPU is housed within the Royal Hospital for Sick Children (Yorkhill), case notes from here can be accessed and reviewed by a Nurse Advisor to identify any relevant information • Health information outwith Glasgow and Clyde area can be included (although not fully comprehensive) • Inclusion of health information in the investigation process allowing decisions and actions to be based on as comprehensive a range of information as is possible.
14.4. Limitations are as follows:
• Process is heavily reliant on IT systems and therefore is only as good as the data on file
41 • Not all systems can be accessed, e.g. A&E sites other than Yorkhill, although work is ongoing to improve this • There may be some unavoidable delays due either to IT problems, organisational change leading to difficulties in sourcing information or complexities in identifying the child. (e.g. changes of surname, different spellings of names etc) • This service does not at this stage, include full analysis of all health information.
14.5. A template has been designed for use in recording this information. (See APPENDIX 10.) A copy will be passed to the social worker, police or health worker requesting the information and a copy retained in the CPU for monitoring purposes.
15. Training
15.1. All staff should be trained in child welfare and protection to ensure competency in the discharge of their duties. A framework for standards in this area is set out in the NHSGGC strategic Training Plan 2007. A training calendar of courses is produced regularly by the Child Protection Unit.
16. Key contributors
NHSGGC Child Protection Unit
NHSGGC Child Protection Forum
NHSGGC Operational Group (Partnerships)
NHSGGC Operational Group (Acute)
17. Consultation process
17.1. Consultation via email with the following took place:
NHSGGC Child Protection Forum
NHSGGC Operational Group (Partnerships)
NHSGGC Operational Group (Acute)
Child Protection Committee Lead Officers
Yorkhill Family Council
42
APPENDIX 1
Getting it right for every child
43
APPENDIX 2
W h a Being Healthy t Everyday care and help I n e e Keeping me safe Learning and achieving d
p fr lo o Being there for me Being able to communicate e m v e p d e o Play, encouragement and fun d p Confidence in who I am n l a e The Whole Me w Guidance, supporting me to Learning to be w h ro o make the right choices responsible g Physical, social, I lo educational, o Becoming independent, w k Knowing what is going to o emotional, spiritual a looking after myself H f happen and when & psychological te r development m Enjoying family and e Understanding my friends family’s background My wider world and beliefs
Support from family, School Enough money Work opportunities for my family friends and other people Local resources Comfortabl e and safe housing Belonging
APPENDIX 3 Board HQ
NHS Board Board Medical Director of Corporate Director of Director of Human Director of Public Health Director of Head of Board Board Nurse Chief Executive Director Planning & Policy Finance Resources (Interim Director) Communications Administration Director
Tom Divers Brian Cowan Catriona Renfrew Douglas Griffin Ian Reid Linda de Castecker Ally McLaws John Hamilton Rosslyn Crocket
Acute Partnerships
Acute Division Chief Director of Acute Service Director of IT West Glasgow CHSCP Operating Officer Strategy Implementation (Interim Director) Director Karen Murray (Acting) & Planning Robert Calderwood Helen Byrne Keith Moore Medical Director East Glasgow CHSCP Glasgow Addiction Services Partnership Brian Cowan Director Mark Feinmann Joint General Manager Neil Hunter Head of Prescribing Director of Oral Health Director of Regional Services & Pharmacy Policy North Glasgow CHSCP Kevin Hill Jonathan Best Nurse Director Director Alex McKenzie Margaret Smith Kate McKean Mental Health Partnership (Interim Director) South West Glasgow CHSCP Anne Hawkins Director of Facilities Director of Women & Director Iona Colvin Alex McIntyre Children’s Services Head of HR Head of Clinical APPENDIX Rosslyn Crocket Anne Macpherson Governance South East Glasgow CHSCP Learning Disabilities Partnership Andrew Crawford Director Cathie Cowan Joint General Manager Director of Diagnostics Director of Emergency Care Michael McClements Jim Crombie & Medical Services Finance Director Grant Archibald Peter Gallacher East Dunbartonshire CHP Director of Health Director James Hobson (Acting) Information Glasgow Homelessness Partnership Director of Surgery & Director of Rehabilitation & Head of Homelessness Partnership Anaesthetics Assessment Head of Admin Situation Vacant West Dunbartonshire CHP Catherine Jamieson Jane Grant Anne Harkness Gavin Barclay Director Keith Redpath
East Renfrewshire CHCP Director Julie Murray
APPENDIX 4
C
r
APPENDIX 6
Social Work Contacts Area Teams Alexandria 01389 608080 Barrhead 0141 577 8300 Castlemilk Office 0141 276 5010 Clarkston 0141 577 4000 Clydebank 0141 562 8800 Drumchapel Office 0141 276 4300 Easterhouse Office 0141 276 3410 Gorbals / Govanhill Office 0141 420 0060 Govan Office 0141 276 8840 Greenock 01475 714100 Johnstone 01505 342300 Kirkintilloch 0141 775 1311 Maryhill Office 0141 276 6200 Paisley 0141 842 4031 Parkhead Office 0141 565 0140 Pollok Main Office 0141 276 2940 Port Glasgow 01475 714900 Renfrew 0141 886 5784 Royston Office 0141 276 7010 Rutherglen / Cambuslang 0141 647 9977 Social Work Out of Hours Service 0800 811 505 Social Work Out of Hours Service 0141 305 6706 ( Health Staff Number Only)
APPENDIX 7
NHSGG Contacts
Child Protection Unit Marie Valente Head of Child Protection Development 0141.201.6970 Dr. Jean Herbison Clinical Director of Child Protection 0141.201.9360 Dr. Kerry Milligan GP SPi Child Protection 0141.201.0468 Elaine Smith Child Protection Advisor 0141.201.0484 Rita Brown Child Protection Advisor 0141.201.0485 Anne Marie Knox Child Protection Advisor 0141. 201.0484 Janice Brown Child Protection Advisor 0141.201.0485 Fiona Miller Child Protection Advisor 0141.201.0468 Carol Bews Child Protection Advisor 0141.201.0468 Irene McGugan Child Protection Advisor 0141.201.0468 Mhairi Cavanagh Child Protection Trainer 0141.201.0489 Elly Albrow Child Protection Trainer 0141.201.0489 Phyllis Orenes Child Protection Trainer 0141.201.0489 Catherine Martin Business Manager 0141.201.0667 Dorothy Ramsden PA Child Protection Advisors 0141.201.0642 Marian McGeever Medical Secretary to CP 0141.201.9225 Paediatricians Lee Ramsay PA Child Protection Trainers 0141.201.9253 Vacancy PA to Clinical Director 0141.201.9360 Sharon Menzies / Child Protection Administrators – 0141.201.1740 Karina Hamilton Early Sharing and Collation of Information
NHSGGC Contacts Cont’d
HOSPITALS, GLASGOW Hospital Switchboard GRI 211 4000 84 Castle Street Glasgow G4 0AS Royal Hospital for Sick 201 0000 Children (RHSC) Dalnair Street Glasgow G3 8SJ Stobhill 201 3000 133 Balornock Road Glasgow G21 3UT Southern General 201 1100 Hospital 1345 Govan Road Glasgow G21 3UT Victoria Infirmary 201 6000 Langside Road Glasgow G42 9TY Western Infirmary 211 2000 General Dumbarton Road Glasgow G11 6NT Gartnavel Royal 211 3600 1055 Great Western Road Glasgow G12 0XH Gartnavel General 211 3000 1053 Great Western Road Glasgow G12 0YN
NHSGGC Contacts Cont’d
HOSPITALS CLYDE Hospital Switchboard Royal Alexandria Hospital 887 9111 (RAH) Corsebar Road Paisley PA2 9PN
Inverclyde Royal 01475 Larkfield Road 633777 Greenock PA16 0XN Inverclyde 01475 Skylark (Pre-School) 633777 Larkfield Road (Inverclyde Greenock PA16 0XN Royal Switchboard) Vale of Leven 01389 Main Street 754121 Alexandria G93 08A
Other Services Service Contact Name Contact Number NHS 24 Gwen Proctor 0131 300 4418 / 0131 300 Norseman House 4401 South Queens Ferry Mobile – 07795 052433 Edinburgh GEMS For Glasgow & Clyde 616 6200 Joan Barr Fax – 616 6201 [email protected] Mobile - 07717851046
NHSGGC Contacts Cont’d
CHPs CHP CONTACT NAME CONTACT DETAILS North Glasgow CHCP Director – Alex MacKenzie 0141.201.4214 [email protected]
East Glasgow CHCP Director – Mark Feinmann 0141.277.7470 [email protected]
West Glasgow CHCP Director – Karen Murray (Acting) 0141. 211 3647. [email protected] South West Glasgow CHCP Director - Iona Colvin 0141.276.4673 [email protected]
South East Glasgow CHCP Director – Cathie Cowan 0141.276.6710 [email protected]
East Dunbartonshire CHP Director – James Hobson (Acting) 0141.201. 4217 [email protected]
West Dunbartonshire CHP Director – Keith Redpath 01389.812334 [email protected] East Renfrewshire CHCP Director – Julie Murray 0141.577.3844 [email protected]
South Lanarkshire CHP General Manager – Lena Collins 0141.584.2509 (Rutherglen & Cambuslang [email protected] Locality) Renfrewshire CHP Director – David Leese 0141.314.0439 [email protected] Inverclyde CHP Director – David Walker 0141.201.4754 [email protected]
NHSGGC Contacts Cont’d
Health Centres Alexandria Medical Centre 01389 752 419 46-62 Bank Street G83 0NB Baillieston Health Centre 0141 531 8000 20 Muirside Road G69 7AD Bank Street (Alexandria) Clinic 01389 81700 46-62 Bank Street G83 0LS Bishopton Health Centre 01505 863223 Greenock Road PA7 5AW Boglestone Clinic 01475 701058 Dubbs Road PA14 5UA Bridgeton Health Centre 0141 531 6500 201 Abercromby Street G40 2DA Cambuslang Clinic 0141 641 2085 Johnston Drive, G72 Cambuslang Gate 0141 584 2509 Main Street, G72 Cardonald Clinic 0141 892 6070 74 Berryknowes Road G52 2TT Castlemilk Health Centre 0141 531 8500 Dougrie Drive G45 9AW Clarkston Clinic 0141 300 1200 56 Busby Road G76 7AT Clydebank Health Centre 0141 531 6300 Kilbowie Road G81 2TQ Drumchapel Health Centre 0141 211 6070 80/90 Kinfauns Drive G15 7TS Dumbarton Health Centre 01389 763 111 Station Road G82 1PW Easterhouse Health Centre 0141 531 8100 9 Auchinlea Road G34 9HQ Elderpark Clinic 0141 232 7100 20 Arklet Road G51 3XR Erskine Health Centre 0141 812 4044 Bargarran Square PA8 6BS Erskineview Clinic 01389 872575 Erskineview G60 5JG Ferguslie Clinic 0141 849 0554 Tannahill Centre PA3 1NT Fernbank Clinic 0141 589 8000 194 Fernbank Street G22 6BD Foxbar Clinic 01505 813119 Morar Drive PA2 9QR Glenburn Health Centre 0141 884 3221 Fairway Avenue PA2 8DX Gorbals Health Centre 0141 531 8200 45 Pine Place G5 9AW Gourock Health Centre 01475 634617 181 Shore Street PA19 1AQ
Govan Health Centre 0141 531 8400 5 Drumoyne Road G51 4BJ Govanhill Health Centre 0141 531 8300 233 Calder Street G42 7DR Greenock Health Centre 01475 724477 20 Duncan Street PA15 4LY Hunter Street Health and Social Care 0141 553 2801 55 Hunter Street G4 0UP Centre Johnstone Health Clinic 01505 320278 60 Quarry Street PA5 8EY Kenmure Medical Practice 0141 772 6309 7 Springfield Road G64 1PJ Kessington Medical Centre 0141 211 5621 85 Milngavie Road G61 2DN Larkfield Child & Family Centre 01475 633777 Larkfield Road PA16 0XN Lennoxtown Clinic 01360 310357 103 Main Street G65 7DB Linwood Health Centre 01505 324337 Adrlamont Square PA3 3DE Maryhill Health Centre 0141 531 8700 41 Shawpark Street G20 9DR Milngavie Clinic 0141 232 4800 North Campbell Avenue G62 7AA Muirhead Clinic 0141 779 1941 192 Cumbernauld Road G69 9NF New Sneddon Street Clinic 0141 848 1296 8 New Sneddon Street PA3 2AD Parkhead Health Centre 0141 531 9000 101 Salamanca Street G31 5BA Partick Community Centre for Health 0141 211 1400 547 Dumbarton Road G11 6HU Plean Street Clinic 0141 232 4708 18 Plean Street G14 0YJ Pollok Health Centre 0141 531 6800 21 Cowglen Road G53 6EQ Pollokshaws Clinic 0141 577 7720 35 Wellgreen G43 1RR Port Glasgow Health Centre 01475 724477 2 Bay Street PA14 5EW Possilpark Health Centre 0141 531 6120 85 Denmark Street G22 5EG Renfrew Health Centre 0141 886 3535 103 Paisley Road PA4 8LH Renton Integrated Healthy Living Centre 01389 722 250 Main Street G82 4PD Russell Institute 0141 889 8701 30 Causeyside Street PA1 1UR Rutherglen Primary Care Centre 0141 531 6015 130 Stonelaw Road G73 3PQ Shettleston Health Centre 0141 531 6200 420 Old Shettleston Road G32 1RT
Springburn Health Centre 0141 531 6700 200 Springburn Way G21 2DA Thornliebank Health Centre 0141 531 6900 20 Kennishead Road G46 8NY Torrance Clinic 01360 620 516 51 Main Street G64 4EX Townhead Clinic (Kirkintilloch) 0141 304 7400 Lenzie Road G66 3BQ Townhead Health Centre 0141 531 8900 16 Alexandra Parade G31 2ES Turret Medical Centre 0141 211 8260 Catherine Street G66 1JB William Street Clinic 0141 314 6200 120-130 William Street G3 8HS Woodside Health Centre 0141 531 9200 Barr Street G20 7LR
APPENDIX 8 Notification of concerns about a child to Social Work Services.
1a. REFERRAL DETAILS Name of Referrer Agency Designation Postal Address Email Phone Fax (include postcode)
1b. DESIGNATED CONTACT PERSON (IF DIFFERENT FROM 1a) Name of Referrer Agency Designation Postal Address Email Phone Fax (include postcode)
2. REFERRAL TO Date of Time of Name of worker spoken to Designation Is the parent/carer aware Is the young person aware of this referral? Referral Referral of this referral? Yes/No? (am or pm) Yes/No?
Area/Hospital Social Work Responsible Local Phone Is this a re-referral from If yes, please enter date(s) of previous Team Authority your service? Yes/No referral(s)
3. SUBJECT OF REFERRAL
Child’s Name Other name DOB Age Gender Home Address Ethnicity Religion known by dd mm yy (M/F) (include Postcode)
1
2
3
Child Affected by Disability
Preferred Language Description Communication Assistance Interpreter Required (specify) Required (specify) 1
2
3
4. FAMILY DETAILS
Other name Current Address DOB Other name Current Address Mother’s Name DOB Father’s Name (If Known) known by (If different from child) (if known) known by (if different from child)
4. FAMILY DETAILS (cont’d) Principal Carer’s Details (if different from Mother/Father)
Is Child Address Family Address Currently If No, state Address Relationship Type of Residence Phone Name DOB (including (include postcode) (if known) Resident at this (include postcode) (if known) to Child (if not at home) postcode) Address?Yes/No
Other Adults in Household Any Other Significant Adult(s) (if known, please include contact details) DOB DOB Name Relationship to Child Name Address Phone Relationship to Child (if known) (if known)
Siblings not subject to referral Child’s Name Other name known by DOB Age Gender If in relation to unborn baby or mother is dd mm yy pregnant – Estimated Date of Birth
5. SUMMARY OF CONCERNS
FOR ALL OTHER REFERRALS PLEASE COMPLETE THE FOLLOWING IF APPLICABLE PLEASE COMPLETE
Suspicion/risk of (factors relating to the Suspicion/risk of (factors relating to Suspicion/risk of child) parents/ carers)
Absconding Alcohol Abuse Physical Injury Child Safety Asylum Seekers/Refugees Emotional Abuse Education Domestic Abuse Physical Neglect Emotional Care/Development Drug Abuse Non-Organic Failure to Thrive Health – Illness/Disability Housing/Accommodation Sexual Abuse Outwith Parental Control Learning Disability Physical Care/Neglect Mental Illness Self harm Parenting Sexual Exploitation Physical Illness Offender Behaviour Poverty/Financial Substance Misuse Other (please specify below) Other (please specify below)
6. REASON FOR REFERRAL/REQUEST FOR SERVICES: (please record reason for concern and how this impacts on child. If applicable, please indicate alleged abuser. Indicate what action, if any, you have taken prior to the referral).
7. AGREED ACTIONS (Actions agreed during phone referral)
8. AGENCY INVOLVEMENT
Health GP’s Name Address Phone Email
Health Visitor/School Name of Health Visitor/School Nurse Address Phone Email
Education Name of School and Contact Person Address Phone Email (Nursery / School)
Any Other Agencies Name of Agency and Contact Person Address Phone Email (if known)
Please print Signature of Referrer name
Date Please Signature of Line Manager print (if applicable) name
Acknowledgement of Child Welfare/Protection Referral To Social Work Services Social Work Services use only (Return to Referrer within 5 working days) Insert Social Work Services Address
Family Name
SWID No.
Date of Referral
Request Treated as:
Outcome of Referral/request for Services
Any other comments
Practice Team Leader Signature:
Date
2
APPENDIX 9
3
APPENDIX 10 Early Sharing & Collation of Information Form
Date Time Received From (Advisor) Received By (Admin) CALLER DETAILS Name Service
Area Office Tel. No . Fax No. Email
FAMILY DETAILS Family Name
Family Address Postcode
CHP Area of Child / North West South East South West Renfrewshire East Inverclyde Family East Dun West Dun East Ren South Lan North Lan Other Principal Carers Name Relationship to child Aliases DoB (if known)
Other known addresses/ Dates of residence
Children (Index Child First) Forename Surname Aliases DoB CHI Care First Gender Nursery/School. Child 1 Child 2 Child 3 Child 4 Child 5 Unborn EDD REASON FOR REQUEST
INFORMATION AVAILABLE 1 CHI 2 GP Registration History
GP… ………………..……………..………….. ….…… Name… …… ………………..………………………………. ……..………………………………………………….... Address/Tel…………………………………………………... …………...... Dates Registered…......
HV…… … ………….……………….…………………. Name …. ……………………………………….………..…... Address/Tel. Address/tel. no, if different…………………...... Dates Registered…………………………..……………….... …………………………………………………………..
4
3 Medical Advice Line (CPU) 4 CPA Advice Line (CPU)
Date(s)..… ………..…………………………………… Date(s)……………………………………………………… Name of Prof……………………………………………. Name of Prof … ………………………………………..……
Summary/Outcome…………………………………...… Summary/Outcome………………………………………… ………………………………………………………...… ……………………………………………………………… ….…………………………………………………….… ……………………………………………………………… ………………………………………………………..… ……………………………………………………………… ………………………………………………………….. ……………………………………………………………….
5 Previous Referral by Health to Social Work (CPU) 6 Previous Referral by Health to SCRA CPU)
Referred By…… ………………………………….…... Referred By…… ………………………………………...... ………………………………………………………….. ……………………………………………………………….
Date(s)………………………………………………… Date(s)…………………………..…………………………… ………………………………………………………… ………………………………………………………………...
Summary/Outcome…………………………………… Summary/Outcome…………………………………………. ………………………………………………………… ……………………………………………………………….. …………………………………………………………. ………………………………………………………………..
7 Previous Reports by NHS 24 to CPU 8 Missing Family Alerts (CPU)
Submitted By …...... Submitted By ………… ……….…………..
Date…………………………………………………… Date………………………………………………………… …………………………………………………. ………………………………………………………………
9 Hospital Information Support System (Yorkhill) 10 Educational Download
Hosp. No. School Nurse
Dates/Department… …………. Name… ………………….
Case Notes Reviewed Base ….… …………………….. By………………………………………………………. Tel No….………………..…………………… 11 Clinical Portal (Clinic Visits - Glasgow) 12 Radiology System (Glasgow)
Date(s)… …………...... Date(s)… ………………………………………………….. Hospital(s)……………………………………………… Hospital………………………………………………………. Clinic...... Type of X-ray …… …………………………………………
Date(s)………………………………………………….. Date(s)…………………………………………………….… Hospital(s)……………………………………………… Hospital……………………………………………………… Clinic...... Type of X-ray ………………………………………………..
13 EDIS (GRI/Stobhill/WIG) 14 Other A&Es
Date(s)…….. ………………………….………………. Date(s)……..………………………… ……………………… Hospital/ Hospital/ Clinic...... Clinic......
Date (s)………………………………….……………… Date (s)………………………………….………………….… Hospital/ Hospital/ Clinic...... Clinic......
Date(s)……..… … …..……………………………….. Date (s)………………………………….……………………. Hospital/ Hospital/ Clinic...... Clinic......
5
INFORMATION AVAILABLE 15 Community Paediatricians (CDC) 16 DCFP/ CAMHS
Name………………………....………………………… Name………………………....……………………………….
Base…………………………………………………… Base…………………………………………………………. ………………….………………..…………………… …………….………………..…………………………………
Dates Attended ……………………………………….. Dates Attended……………………………………………… ………………………………………………………… ………………………………….……………………………
17 Homeless Families Health Team 18 LAAC
Contact Name………………………………………….. Name………………………....……………………………….
Dates…………………………………………………… Base………………………………………………………… …………………………………..……………………… …………….………………..……………………………….. Summary/Outcome…………………………………… ………………………………………………………… Dates Attended…………………………………………….. …………………………………………………………. ………………………………………………………………..
19 Asylum Seekers Health Team 20 OTHERS AS APPROPRIATE
Contact Name………………………………………….. Service………………………………………………………
Dates…………………………………………………… Relevant Contact…………………………………………… …………………………………..……………………… ……………………………………………………………… Summary/Outcome…………………………………… ……………………………………………………………… ………………………………………………………… ……………………………………………………………… …………………………………………………………. ………………………………………………………………
21 OTHERS AS APPROPRIATE 22 OTHERS AS APPROPRIATE
Service………………………………………………… Service…………………………………………………
Relevant Contact ………………………………………. Relevant Contact ………………………………………. ………………………………………………………… ……………………………………………………………… ………………………………………………………… ……………………………………………………………… ………………………………………………………… ……………………………………………………………… …………………………………………………………. ………………………………………….
ANY OTHER INFORMATION
Initial information collated by ……………………………. …………..………………………… (Admin Officer)
Passed to….…… ………………………………. …….. Designation… …… ….…………… (CPA/SW)
Date….………….……………. Time………………………
Follow up completed by ……………………………………. Passed to ………………………
Date ……………………….. Time ………………………… 6
APPENDIX 11
Other related policies, procedures and guidance
• MC57 form - health monitoring and tracking
• Monitoring and tracking of missing family alerts
• Shared referral form to Social Work and guidance notes
• Working with sexually active young people – guidance for under 16 year olds
• Base 75
• Child Protection and Domestic Abuse
• Recognition and Management of Maltreatment in Children Under Age of One Year
• Suspected non-accidental head injury (NAHI) in children under 2
• Child Protection Significant Case Review Procedures for NHSGGC
• CP Text 4 U
• Young People Who are Sexually Active - GP Confidentiality (Sandyford)
• The Glasgow protocol for working with young people who are sexually active
• Health staff attendance at case conferences
• Perinatal Unit Admissions
• Procedures to be adopted by the Dental Professional who suspects child abuse
• Standard Operating Procedures (Yorkhill, being rolled out in RAH)
• Child Protection Guideline for NHS Staff working in A and E
• GP deregistration policy
• Early sharing and collation of information
• Children’s Right to Be Treated Fairly
• Child Protection Committees Interagency Guidance
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APPENDIX 12
REFERENCES
Legislation
The Children Scotland Act (1995)
National Policy
Protecting Children: A Shared Responsibility - Guidance for Health Professionals, 1999
It’s Everyone’s Job to Make Sure I’m alright, Scottish Executive, 2002
Protecting Children and Young People: The Framework for Standards, Scottish Executive, 2004a
Protecting Children and Young People: The Charter, Scottish Executive, 2004b
Protecting Children and Young People, Child Protection Committees, Scottish Executive, 2005b
How Well Are Children and Young People Protected and Their Needs Met? Self Evaluation Using Quality Indicators, HMIE, 2005
Evaluation of Services for Children and Young People: Generic Quality Indicators, HMIE, 2006
Getting It Right for Every Child: Proposals for Action, Scottish Executive, 2006
Delivering a Healthy Future: An Action Framework for Children and Young People’s Health in Scotland, Scottish Executive, 2006
Have we got our priorities right? Children living with parental substance use, Aberlour, 2006
Hidden Harm – next Steps: Supporting Children- Working with parents, Scottish Executive, 2006
Emergency Care Framework for Children and Young People in Scotland, Scottish Executive, 2006
Guide to Evaluating Services for Children and Young People Using Quality Indictors” (2007) HMIE
Better Health, Better Care Action Plan, Scottish Government, 2007
NHSGGC documents
NHSGGC Strategic Training Plan (2007)
Inquires into child deaths
Social Services Inspectorate Inspection of Social Services in Cambridgeshire (Rikki Neave Inquiry), DOH, 1997
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Lord Laming, the Victoria Climbié Inquiry, HMSO 2003
O’Brien et al Report of the Caleb Ness Inquiry, Edinburgh and Lothian Child Protection Committee, 2003
Dr Helen Hammond Inquiry into the circumstances surrounding the death of Kennedy McFarlane, Dumfries and Galloway Child Protection Committee, 2000
Professor Pat Cantrill Serious Case Review, Sheffield Area Child Protection Committee, 2005
An Inspection into the Care and Protection of Children in Eilean Siar (The Western Isles Report), Social Work Inspection Agency, 2005
Dr. Jean Herbison Danielle Reid: Independent Review into the circumstances surrounding her death, Highland Child Protection Committee, 2006
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